The Doctors Caucus
Floor Speech
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MR. FLEMING And I still see patients as well when I get a chance, but it's not nearly as often as I'd like. We, being both family physicians, I think we have a special bond. I want to thank the gentleman for his leadership, and certainly he's been a mentor for me, and also a special kind of family practice heart that only we family physicians understand, not just for your patients, but for the work that you do here, and not least of which is for this Republic that I know you love so much. And that, I greatly respect.
What I wanted to extend a little bit from our discussion that we're already into is the fact that, you know, we've had a number of these GOP Doctors Caucus Special Orders during the health care debate, and tonight we know the bill is passed. There's nothing we can say tonight that's going to keep it from being passed. The votes have all been counted and it is in law; although, it's not been fully implemented.
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MR. FLEMING Right. Well it's a quasi-medical term which is equivalent to armchair quarterbacking or postmortem in which we look back and we go, How do things look now, looking back, as opposed to the way they looked then? You know, what we were saying during the debate is this: This bill is by no means really paid for, that there is smoke and mirrors about the financing, that it will definitely cost tax for the middle class, although the President said otherwise.
The President said premiums would go down for insurance. We said they would go up. The President said people would get more care and better care, and we said, no, the care would be diluted, there would be less access to care.
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MR. FLEMING So there were a number of promises made and, you know, each time we tried to rebut these, we were told that we were using scare tactics, that we are scaring old people and that, really, it was unconscionable to do that.
So what has happened since the bill was passed? Well, first of all, the bill had about 52 percent of Americans who were against it, against 38 percent who were for it. Today, 63 percent of Americans want repeal, so that means that more people now want to get rid of this bill than actually were against it before. That means that some people who were for it now want to repeal it.
And what was the first thing we heard after it passed? Almost within 24 hours, AT&T a write-down of $1 billion, that is a loss of $1 billion for the year; Verizon, $970 million; John Deere, $150 million; Caterpillar, $100 million.
We had communication just the other day, a small business owner who thought he was going to be okay under ObamaCare because he had 24 employees, and he said, you know, the threshold is 25 employees, so you get special tax credits and you get support under this program because you are a small business owner that has fewer employees.
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Mr. FLEMING. Yes, what's happening is the employers, now that they are getting the language of the bill--remember that Speaker Pelosi said if we want to find out what's in it, we have got to pass it first, okay? Well, now it's passed. So, now, business owners are putting the pencil to it.
Here is what they are finding. This is a gentleman who said, you know, I have got 24 employees. So I should be under the threshold, and I should actually get some subsidies and tax credits.
But what he found out was that the way it's calculated, he would have to draw down his 24 employees to 10, and he would have to cut wages down to $25,000 a year, fine print. The gentleman's name is Zach Hoffman.
He is going to have to go from 24 employees making an ample of $35,000 a year down to 10 years making $25,000, $35,000 versus $25,000 a year in order to make that happen. But that's not all. Remember, what I am telling you is not me telling you this. I am just passing on the bad news. Don't shoot the messenger here, okay.
What I am telling you is what people are finding out. The President's chief actuary, this is from, this is in the President's administration, soon after the bill was passed, said, You know what, we made a miscalculation on this. That's from CMS, that this is going to cost $311 billion more than what was anticipated and that it will consume 21 percent of gross domestic product instead of the 16 percent that we predicted. This was within days of it passing.
And then also the CBO, the Congressional Budget Office, which we know played along with the smoke and mirrors and the sleight-of-hand financing of this says, oh, my goodness, there's $115 billion that we haven't accounted for. So instead of this thing being revenue neutral or maybe a little bit on the plus side, no, it is going to go in the red just like we were saying all along.
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MR. FLEMING But it goes further than that. There's going to be $120 billion in taxes that were not anticipated. That's on top of the $600 billion that were already----
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MR. FLEMING Additional tax from the actuary who is saying it's going to be more taxes. Job cuts: 90 percent of medical device makers say that they will eliminate jobs. That's 9 out of 10 companies that make anything from tongue blades to pacemakers, what have you, as a result of the taxation, heavy taxation, excise taxation of medical devices.
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Mr. FLEMING. Yes. So you have costs going up and you have jobs going down. We know that there's supposed to be 32 million more Americans covered under this than otherwise. Half of those are to be estimated to be going into Medicaid. And doctors across the country are dropping Medicaid.
Where are these people going to end up? They are going to end up in emergency rooms, not in the doctors's offices like was anticipated.
But let me get to something that I think is real important because you remember that we brought up the idea that there would be committees that may make a decision about what kind of treatment you may or may not get? Now, we know that they exist in Canada and in the United Kingdom, but we started talking about these. I know that Sarah Palin, Governor Palin, made mention of this and the left blew apart. They said, my goodness, you are talking about death boards. Shame on you for scaring the American people.
Okay, well, let me tell you what's really happening, and this is being reported now. The President has nominated Dr. Donald Berwick to run the Centers for Medicare and Medicaid Services, that's CMS, and his job is to oversee CMS. He is also supposed to oversee the $2.5 billion comparative effectiveness research.
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MR. FLEMING Well, what it basically means is that there's going to be a bunch of unelected bureaucrats, perhaps not even doctors, who are going to be tasked with looking at research, hopefully there's going to be research or they are going to do research, to decide what treatments and what diagnostic tests are worth paying for and which ones are not.
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Mr. FLEMING. Right. This is his quote. He considers the British health system ``a global treasure.'' In fact, it's my understanding--I don't have it in my data right here--it's my understanding that he helped design it. And it's designed very simply just to be--a little more technical than what you were describing--is that what they do is they take the population and they assign a value, a numerical value based on quality-adjusted life years. And so just as you say, let's say that the government can afford 1,000 hip replacements this year because of the budget and you've got someone who's 75 with diabetes and let's say somebody 35 who's fully healthy----
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Mr. FLEMING. A football player, okay. Now, according to the quality-adjusted life years, the 35-year-old has not only more years left to live, but he has more productive years, that is, he's going to work for the state more years. In fact, the 75-year-old probably is not going to work any more years. And so they have to draw the line someplace: Which thousand is going to get the hip replacement this year? And guess which one it's going to be? It's going to be the 35-year-old. That is the way the comparative effectiveness system works.
That's the way they do it in England today. And anybody who's skeptical or doubts that that's where we're headed, they just need to read about Dr. Berwick and all the other information that's coming out on this. And again, there is much reported by The Wall Street Journal. It says, The decision is not whether or not we will ration care--according to The Wall Street Journal--the decision is whether we will ration with our eyes open. And right now, we are doing it blindly.
It goes on and on to describe the fact that if the quality effectiveness research board is not, in essence, a death panel, then I don't know what really is because, just in the case with the gentleman with the prostate cancer, that's a decision between him and his doctor whether he gets chemotherapy, whether or not he can get surgery. Or maybe he decides, he and his doctor, that the cancer has advanced too far and he's just going to go home, take pain medication, and not fight it. Some people decide that, but that is their decision. But this is going to make it the government's decision to do that.
If you doubt that that happens, again, go and talk to people from the United Kingdom and from Canada. It happens all the time. It's acceptable in those countries and in those cultures that if the government says you don't get treatment or you get only palliative treatment when there is a cure, then that is strictly the way it is. And as far as I know, there is no right to petition; there is no court or anything that you can go to.
So what we really have, just to summarize my comments here, is we had a number of promises by the President. He said the cost curve would go down, as you say; he said the middle class would not pay increased taxes; he said the premiums would go down; and he said a number of other things that I can't even think of today. He scoffed at the idea of death panels and any kind of board or bureaucrat that would dictate what your care would be like, whether the bureaucracy or government would come between you and your physician.
And he said that businesses would be happy, that this would be a boon for businesses. Well, today, where are we? None of those things have proven to be true. Now that the bill is in law, we have businesses not hiring people because we have an unemployment rate of 9.9 and holding because businesses know that if they hire people, they're going to have to pay a lot of money for their health care coming forward. And we also know that what we feared the most is actually in play, and that is that we will have a board, a comparative effectiveness board, just like that in the United Kingdom.
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Mr. FLEMING. If you would yield for just a comment about employers.
I'm a small business owner, and you, as a medical physician and one who has to run a business, in essence, for health care, I think a lot of people out there may feel safe in the fact that, you know, my employer has always taken care of us, they've always stepped up and done the right thing. But what people have to understand is that if an employer is paying these high premiums and their competitor is not paying those high premiums or reduces the number of employees, then your employer is no longer competitive in the marketplace, and he either has to do the same thing or he goes out of business.
So it's not like you can take comfort in the fact that, well, my employer always does the right thing, he always steps up and he always buys us insurance. This is a whole new paradigm because he's going to be competing; and if his costs are higher, then he's going to go out of business or match what the other one does.
I yield back.
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